"The central doctrine of Christianity, then, is not that God is a bastard. It is, in the words of the late Dominican theologian Herbert McCabe, that if you don’t love you’re dead, and if you do, they’ll kill you."--Terry Eagleton

"It is impossible for me to say in my book one word about all that music has meant in my life. How then can I hope to be understood?--Ludwig Wittgenstein

“The opposite of poverty is not wealth; the opposite of poverty is justice."--Bryan Stevenson

Monday, July 11, 2011

Is This A Great Country, Or What?

Everyone on TeeVee and radio agrees life expectancy in the US is higher than it was in 1935 when Social Security was made law. Of course, nobody on TeeVee or the radio lives in Mississippi.

But the US is a big country, and while parts of Mississippi have a male life expectancy of 67, behind nations like the Philippines, women in areas of Florida live as long, on average, as the Japanese, who top the longevity rankings.

Life expectancy is one of those slippery concepts that isn't nearly as unitary as we think it is. For one thing, life expectancy at birth and life expectancy at 65 years old are different things. As the Social Security Administration helpfully points out that,, the life expectancy for males who reached 65 in 1935 as 12.7 more years. In 1990, it was 15.3 more years. The increase in the number of 65 year olds in the country is due to a growing population, i.e., a larger cohort of persons available to live to 65. What, then about the life expectancy in Mississippi? Obesity is a prime factor. Obesity rates in the US have gone ever upward since the late '70's. We see so few such people in public life that Chris Christie is still an anomaly among public figures, although obviously he isn't among the US population. Obesity, according to the BBC article, is one of the factors driving "early death" among Americans. 1 in 3 Americans, per that report, is classified as "obese." But you don't see those people sitting in the pundit chairs or among the chattering classes. They aren't telegenic.

When pundits and pooh-bahs declaim that people are living longer than they did in 1935, it isn't based on statistics or an understanding of numbers. What the pundits and pooh-bahs see is not the people in Mississippi who have little or no access to good health care, and who have problems with obesity and tobacco consumption (nobody on TeeVee smokes or is fat). They see people like them. They refuse to see the inequality in the system. But don't take my word for it. Compare the BBC article:

It is precisely this kind of inequality that goes some way to explain why the US - and the UK to a lesser degree - lag behind other countries, according to Danny Dorling, a professor of human geography at the University of Sheffield in the UK.

He believes a more even distribution of wealth, even if the average were lower, could mean longer lives for everyone.

"I think stress is a part of it - this is the key thesis of Michael Marmot and his book on the status syndrome. People get worn out faster with greater inequality.

"However there is much more. If you have most health spending just going on a few people who have the best health to begin with - [as in] the US system - that is hardly efficient.

"In a more unequal rich country more doctors are working on things like plastic surgery. More dentists whiten teeth than fix bad teeth and so on."

Why are life expectancy estimates rising in some counties and falling in others? Murray and his colleagues say it's not issues like poverty or racial makeup that explain the difference, but high rates of obesity, smoking and other preventable health problems.

Some experts disagree, saying the findings may be tied to the availability of good health care or with the migration of healthy people from one place to another. But Murray said his research finds migration theories are not the answer - there's been little movement in or out of most places with the lowest life expectancy. In several cases, counties with plummeting life expectancy were next to or very near counties with rising longevity.

Where should you live if you want the best shot at a long life? Metro areas with lush jobs and universities - Georgia's Fulton County (Atlanta), Washington, Alexandria, Va., and New York City for men - or Alexandria and a Wyoming county home to the affluent Jackson Hole, for women.

Notice the objective even-handedness of "some experts disagree." And then it quickly abandons any mention of access to healthcare, and ignores entirely any problem of obesity. Besides, the answer is clear! It's not how you live, it's where you live! Get out of Mississippi now! Move to Jackson Hole, or Alexandria, or New York City! Hey! It's a free country! Ain't no inequality here!

The British expert mentions dental care, which is almost an Austin Powers joke on this side of the pond. But do you ever see anybody on TeeVee with really bad teeth? I mean, really? The chattering classes all live within an enclave of beautiful teeth and thin people who never smoke and get regular checkups. It's significant the BBC is reporting this story. As best I can tell, NPR is covering it on their "health blog," and getting the message wrong, again:

Americans may be living longer than ever, but we're lagging behind the life expectancies for the leading nations in the world. A fresh analysis shows there are wide variations in how long Americans can expect to live, depending on their county of residence. Obesity and smoking are problems.

Some of us are living longer. Some of us aren't. The World Bank shows a rise in American life expectancy of almost 9 years over 5 decades. That helps put Mississippi in perspective. They aren't enjoying that rise in longevity, or if they are it is up from a deep bottom indeed. The reasons are stark, but we don't want to talk about them. We'd rather talk about budget deficits and reducing government spending 10 years from now (the money we're spending now was committed years ago). We'd rather be innumerate and stupid about statistics and look around and see our rich, privileged friends are living longer, so this must be the best of all possible worlds. I am reminded again of who Jesus of Nazareth ate and drank and talked with, and who he didn't. Life expectancy was probably greater for the wealthy in Rome and Palestine, too, than it was for beggars and fishermen and carpenters.

Stanford neuroscientist Robert Sapolsky has spoken and written a lot about stress-caused diseases, especially in his book, WHY ZEBRAS DON'T GET ULCERS (which I'm currently reading). Simplifying what he has to say, in the animal world, stress-response is short-term and followed by a stress-recovery phase (assuming you aren't eaten by the stressor). In humans, where stress can be continuous (for example, in the poorer classes) and where worrying about the future is possible, the stress-response can be continuous also - the recovery phase never takes place. The continuous stress-response (which can include things like suppressing the immune system) can and does have deleterious effects on health. (Again, I'm simplifying what he has to say. The very readable book delves into the many hormones - but he doesn't expect you to remember them all - released by the stress-response and how they affect the body.)

Here's a 50-minute YouTube video of Sapolsky talking about depression and stress and their effects on the overall health of a person: